Study on the incidence of adverse events during intrahospital transfer of critical care patients from emergency department
Mohd Rafeek Mohd Ismai
;
Kamarul Aryffin Baharuddin
;
Zainal Effendy Zainal Abidin
;
Mimi Azliha Abu Bakar
;
Afifah Sjamun Sjahid
The Medical Journal of Malaysia.2020;75(4):325-330.
Introduction: Emergency department (ED) plays a main role in
the initial management of patients who are critically ill. These
patients require intra-hospital transfer for continuation of
care. Adverse events can occur during this short duration and
the distance of intra -hospital transfer. The aims of this study
were to determine the incidence of adverse events during intrahospital transfer from ED and to determine the factors
associated.
Methodology: This was a cross-sectional observational study
done from November 2017 until December 2017 at ED Hospital
Sultan Abdul Halim (HSAH), a 650-bedded tertiary hospital in
the state of Kedah. All patients that were triaged to red zone,
age 18 years and above, and involved in intra-hospital transfer
to critical coronary unit, intensive care unit and wards were
included. All cases were documented in proforma by the
accompanying staff.
Results: Among the 170 critically ill patients, only 29 patients
(17.1%) experienced adverse events during intra-hospital
transfer. The adverse events seen were hypotension (12.4%),
desaturation (3.5%) and dislodged peripheral line (2.4%).
Cardiorespiratory related diagnosis was the commonest
presentation. Intra-hospital transfer during morning shift and
evening shift has 79.5% (b=-1.59, OR=0.21, 95% CI: 0.06, 0.69,
p=0.011) and 75.6% ((b=-1.41, OR=0.24, 95% CI: 0.08, 0.73,
p=0.012) lesser odds of experiencing adverse events compare to
night shift. Patients with vasopressor/inotropes had 9 times
higher odds of experiencing adverse events during
transportation, compared to patients with no
vasopressor/inotropes (b=2.27, OR=9.70, 95% CI: 3.39, 27.72,
p<0.001).
Conclusions: Critical care patients who are involved in intrahospital transfer were at risk of adverse events such as
hypotension, desaturation and dislodge peripheral line. Risk
identification and maintaining level of care is important to
minimize the adverse events during transfer. Patients had
higher rates of adverse events if they were transferred during
night shifts and on inotropic/vasopressor support
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